<?xml version="1.0" encoding="utf-8"?>
<brl xmlns="http://schemas.microsoft.com/businessruleslanguage/2002">
  <ruleset name="ClaimRouting">
    <version major="1" minor="1" description="" modifiedby="PLATBRIEF1\Administrator" date="2007-04-08T15:41:13.0089888-04:00" />
    <configuration />
    <bindings>
      <xmldocument ref="xml_31" doctype="HealthcareClaimSchemas.RoutingControl" instances="16" selectivity="1" instance="0">
        <selector>/*[local-name()='Root' and namespace-uri()='http://HealthcareClaimSchemas.RoutingControl']</selector>
        <schema>C:\Demonstrations\HealthCareClaims\Solution Files\HealthcareClaims no SubDocuments\HealthcareClaims Schemas\RoutingControl.xsd</schema>
      </xmldocument>
    </bindings>
    <rule name="Availity" priority="20" active="true">
      <if>
        <or>
          <compare operator="equal">
            <vocabularylink uri="3f0e9bcc-6212-4e6a-853c-e517f157a626" element="05703dd9-1111-40b8-890d-ad7bfc45a925" />
            <lhs>
              <function>
                <vocabularylink uri="931b46d5-77a4-4447-a643-dde611f51e50" element="b0316bb6-6a56-4f4f-af1e-5027f52f4eb6" />
                <xmldocumentmember xmldocumentref="xml_31" type="string" sideeffects="false">
                  <field>*[local-name()='PayerID' and namespace-uri()='']</field>
                  <fieldalias>PayerID</fieldalias>
                </xmldocumentmember>
              </function>
            </lhs>
            <rhs>
              <constant>
                <vocabularylink uri="931b46d5-77a4-4447-a643-dde611f51e50" element="59c5ddbf-5c74-4d2b-b0ec-0ed8159bceee" />
                <string>00090</string>
              </constant>
            </rhs>
          </compare>
          <compare operator="equal">
            <vocabularylink uri="3f0e9bcc-6212-4e6a-853c-e517f157a626" element="05703dd9-1111-40b8-890d-ad7bfc45a925" />
            <lhs>
              <function>
                <vocabularylink uri="931b46d5-77a4-4447-a643-dde611f51e50" element="b0316bb6-6a56-4f4f-af1e-5027f52f4eb6" />
                <xmldocumentmember xmldocumentref="xml_31" type="string" sideeffects="false">
                  <field>*[local-name()='PayerID' and namespace-uri()='']</field>
                  <fieldalias>PayerID</fieldalias>
                </xmldocumentmember>
              </function>
            </lhs>
            <rhs>
              <constant>
                <vocabularylink uri="931b46d5-77a4-4447-a643-dde611f51e50" element="fbdf6bfc-63f5-4632-b882-d2daa50b3e7c" />
                <string>61101</string>
              </constant>
            </rhs>
          </compare>
          <compare operator="equal">
            <vocabularylink uri="3f0e9bcc-6212-4e6a-853c-e517f157a626" element="05703dd9-1111-40b8-890d-ad7bfc45a925" />
            <lhs>
              <function>
                <vocabularylink uri="931b46d5-77a4-4447-a643-dde611f51e50" element="b0316bb6-6a56-4f4f-af1e-5027f52f4eb6" />
                <xmldocumentmember xmldocumentref="xml_31" type="string" sideeffects="false">
                  <field>*[local-name()='PayerID' and namespace-uri()='']</field>
                  <fieldalias>PayerID</fieldalias>
                </xmldocumentmember>
              </function>
            </lhs>
            <rhs>
              <constant>
                <string>BLUE CROSS</string>
              </constant>
            </rhs>
          </compare>
          <compare operator="equal">
            <vocabularylink uri="3f0e9bcc-6212-4e6a-853c-e517f157a626" element="05703dd9-1111-40b8-890d-ad7bfc45a925" />
            <lhs>
              <function>
                <vocabularylink uri="931b46d5-77a4-4447-a643-dde611f51e50" element="b0316bb6-6a56-4f4f-af1e-5027f52f4eb6" />
                <xmldocumentmember xmldocumentref="xml_31" type="string" sideeffects="false">
                  <field>*[local-name()='PayerID' and namespace-uri()='']</field>
                  <fieldalias>PayerID</fieldalias>
                </xmldocumentmember>
              </function>
            </lhs>
            <rhs>
              <constant>
                <string>BCBSF</string>
              </constant>
            </rhs>
          </compare>
          <compare operator="equal">
            <vocabularylink uri="3f0e9bcc-6212-4e6a-853c-e517f157a626" element="05703dd9-1111-40b8-890d-ad7bfc45a925" />
            <lhs>
              <function>
                <vocabularylink uri="931b46d5-77a4-4447-a643-dde611f51e50" element="b0316bb6-6a56-4f4f-af1e-5027f52f4eb6" />
                <xmldocumentmember xmldocumentref="xml_31" type="string" sideeffects="false">
                  <field>*[local-name()='PayerID' and namespace-uri()='']</field>
                  <fieldalias>PayerID</fieldalias>
                </xmldocumentmember>
              </function>
            </lhs>
            <rhs>
              <constant>
                <string>AETNA</string>
              </constant>
            </rhs>
          </compare>
          <compare operator="equal">
            <vocabularylink uri="3f0e9bcc-6212-4e6a-853c-e517f157a626" element="05703dd9-1111-40b8-890d-ad7bfc45a925" />
            <lhs>
              <function>
                <vocabularylink uri="931b46d5-77a4-4447-a643-dde611f51e50" element="b0316bb6-6a56-4f4f-af1e-5027f52f4eb6" />
                <xmldocumentmember xmldocumentref="xml_31" type="string" sideeffects="false">
                  <field>*[local-name()='PayerID' and namespace-uri()='']</field>
                  <fieldalias>PayerID</fieldalias>
                </xmldocumentmember>
              </function>
            </lhs>
            <rhs>
              <constant>
                <string>MEDICAID-FL</string>
              </constant>
            </rhs>
          </compare>
        </or>
      </if>
      <then>
        <function>
          <vocabularylink uri="931b46d5-77a4-4447-a643-dde611f51e50" element="9e10acba-7e49-4bf1-bd66-312e0a11fbbc" />
          <xmldocumentmember xmldocumentref="xml_31" type="string" sideeffects="true">
            <field>*[local-name()='RouteTo' and namespace-uri()='']</field>
            <fieldalias>RouteTo</fieldalias>
            <argument>
              <constant>
                <string>Availity</string>
              </constant>
            </argument>
          </xmldocumentmember>
        </function>
      </then>
    </rule>
    <rule name="SendRealTime" priority="60" active="true">
      <if>
        <and>
          <compare operator="equal">
            <vocabularylink uri="3f0e9bcc-6212-4e6a-853c-e517f157a626" element="05703dd9-1111-40b8-890d-ad7bfc45a925" />
            <lhs>
              <function>
                <xmldocumentmember xmldocumentref="xml_31" type="string" sideeffects="false">
                  <field>*[local-name()='RouteTo' and namespace-uri()='']</field>
                  <fieldalias>RouteTo</fieldalias>
                </xmldocumentmember>
              </function>
            </lhs>
            <rhs>
              <constant>
                <string>Availity</string>
              </constant>
            </rhs>
          </compare>
          <compare operator="equal">
            <vocabularylink uri="3f0e9bcc-6212-4e6a-853c-e517f157a626" element="05703dd9-1111-40b8-890d-ad7bfc45a925" />
            <lhs>
              <function>
                <vocabularylink uri="931b46d5-77a4-4447-a643-dde611f51e50" element="b0316bb6-6a56-4f4f-af1e-5027f52f4eb6" />
                <xmldocumentmember xmldocumentref="xml_31" type="string" sideeffects="false">
                  <field>*[local-name()='PayerID' and namespace-uri()='']</field>
                  <fieldalias>PayerID</fieldalias>
                </xmldocumentmember>
              </function>
            </lhs>
            <rhs>
              <constant>
                <string>BCBSF</string>
              </constant>
            </rhs>
          </compare>
        </and>
      </if>
      <then>
        <function>
          <vocabularylink uri="931b46d5-77a4-4447-a643-dde611f51e50" element="d3fe9c2f-54d3-4c56-b731-f031032976ee" />
          <xmldocumentmember xmldocumentref="xml_31" type="string" sideeffects="true">
            <field>*[local-name()='SendRealTime' and namespace-uri()='']</field>
            <fieldalias>SendRealTime</fieldalias>
            <argument>
              <constant>
                <string>No</string>
              </constant>
            </argument>
          </xmldocumentmember>
        </function>
      </then>
    </rule>
    <rule name="BadClaim" priority="10" active="true">
      <if>
        <compare operator="equal">
          <vocabularylink uri="3f0e9bcc-6212-4e6a-853c-e517f157a626" element="05703dd9-1111-40b8-890d-ad7bfc45a925" />
          <lhs>
            <function>
              <vocabularylink uri="931b46d5-77a4-4447-a643-dde611f51e50" element="7a2813b2-30de-42d8-a539-4052bed367e2" />
              <xmldocumentmember xmldocumentref="xml_31" type="string" sideeffects="false">
                <field>*[local-name()='HasValidationErrors' and namespace-uri()='']</field>
                <fieldalias>HasValidationErrors</fieldalias>
              </xmldocumentmember>
            </function>
          </lhs>
          <rhs>
            <constant>
              <string>Yes</string>
            </constant>
          </rhs>
        </compare>
      </if>
      <then>
        <function>
          <vocabularylink uri="931b46d5-77a4-4447-a643-dde611f51e50" element="9e10acba-7e49-4bf1-bd66-312e0a11fbbc" />
          <xmldocumentmember xmldocumentref="xml_31" type="string" sideeffects="true">
            <field>*[local-name()='RouteTo' and namespace-uri()='']</field>
            <fieldalias>RouteTo</fieldalias>
            <argument>
              <constant>
                <string>BadClaim</string>
              </constant>
            </argument>
          </xmldocumentmember>
        </function>
      </then>
    </rule>
    <rule name="ClearingHouse" priority="50" active="true">
      <if>
        <compare operator="not equal">
          <vocabularylink uri="3f0e9bcc-6212-4e6a-853c-e517f157a626" element="c22af575-9920-417c-a545-67fa0ece9832" />
          <lhs>
            <function>
              <xmldocumentmember xmldocumentref="xml_31" type="string" sideeffects="false">
                <field>*[local-name()='RouteTo' and namespace-uri()='']</field>
                <fieldalias>RouteTo</fieldalias>
              </xmldocumentmember>
            </function>
          </lhs>
          <rhs>
            <constant>
              <string>Availity</string>
            </constant>
          </rhs>
        </compare>
      </if>
      <then>
        <function>
          <vocabularylink uri="931b46d5-77a4-4447-a643-dde611f51e50" element="9e10acba-7e49-4bf1-bd66-312e0a11fbbc" />
          <xmldocumentmember xmldocumentref="xml_31" type="string" sideeffects="true">
            <field>*[local-name()='RouteTo' and namespace-uri()='']</field>
            <fieldalias>RouteTo</fieldalias>
            <argument>
              <constant>
                <string>ClearingHouse</string>
              </constant>
            </argument>
          </xmldocumentmember>
        </function>
      </then>
    </rule>
  </ruleset>
</brl>